急性心肌梗死患者冠状动脉内超选择应用替罗非班的临床研究  

Clinical effect of super-selective intracoronary administration on acute myocardial infarction patients

作　　者：苏少辉[1] 叶健烽[1] 何小萍[1] 李大强[1] 熊斌[1] 卢炯斌[1] 林爱玲[1] 

机构地区：[1]广东省东莞市人民医院心内科,523018

出　　处：《中华老年医学杂志》2015年第7期732-735,共4页Chinese Journal of Geriatrics

基　　金：2012广东省医学科研基金立项课题（B2012383）

摘　　要：目的探讨替罗非班在急性心肌梗死患者冠状动脉内超选择中的应用。方法2012年3月至2014年1月在我科进行急诊皮冠状动脉介入治疗（PCI）术的急性ST段抬高型心肌梗死（STEMI）患者240例，数字抽签随机分为静脉给药组（静脉组）77例、常规冠状动脉内给药组（常规组）81例和超选择冠状动脉内给药组（超选择组）82例，比较治疗后3组患者的即刻心肌梗死溶栓治疗（TIMI）血流分级、术后ST段回落率、肌酸激酶同工酶（CK—MB）及肌钙蛋白-I（CTmI）峰值、左心室射血分数、左心室舒张末内径、主要心血管不良事件及出血事件情况。结果3组患者术后即刻TIMI血流差异无统计学意义（X2=0．14，P=0．529），超选择组术后ST段完全回落为61例（74．4％），高于静脉组48例（62．3％）、常规组50例（61．7％）（X2=8．24，P〈0．05）。超选择组CKMB、CTn-I峰值低于静脉组和常规组（P〈0．05）。3组术后左心室舒张末内径和左心室射血分数差异无统计学意义（P〉0．05）；但术后3个月随访，超选择组左心室射血分数（P=0．002）、心绞痛发生率较其他两组改善（P〈0．05）。而在靶病变重建、非致死性心梗、用药后血小板减少3组比较，差异无统计学意义（P〉0．05）。结论替罗非班超选择冠状动脉内给药能增强急性心肌梗死患者的心功能，改善心绞痛症状。Objective To investigate the effect of super-selective intracoronary administration on acute myocardial in farction patients. Methods A total of 240 patients with ST-segment elevation myocardial infarction who received emergency percutaneous coronary intervention in our department from March 2012 to January 2014 were selected and divided into the intravenous drug administration group （n= 77） , the conventional intracoronary drug administration group （n=81 ） and the super-selective intracoronary drug administration group （n = 82）. Parameters. including the Thrombolysis [n Myocardial Infarction （TIMI） classification, ST segment resolution after operation, peak values of creatine kinase MB （CK-MB） and troponin-I （cTn-I）, left ventricular ejection fraction, left ventricular end-diastolic diameter （LVEDD）, major adverse cardiovascular events and bleeding events, were compared between the groups. Results There were no significant differences in TIMI flow grade between the three groups （X2 =0.14, P= 0. 529）. The percentage of patients with complete ST segment resolution after operation was higher in the super-selective intracoronary drug administration group than in the intravenous drug administration and conventional intracoronary drug administration groups （74.4% w 62.3G, 61.7%, X2 =8.24, P〈0.05）. Peak values of CK-MB and cTn-I were lower in the super-selective intracoronary drug administration group than in the other groups （P〈 0.05）. There were no significant differences in left ventricular ejection fraction and LVEDD between the three groups after operation, but left ventricular ejection fraction and the incidence of angina pectoris significantly improved in the super-selective intracoronary drug administration group than in the other groups after a three month follow-up （P〈0.05）. There were no significant differences in target lesion revascularization, nonfatal myocardial infarction and druginduced thrombocytopenia between the three groups （P〉 0. 05 ）. Conclu

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 血小板糖蛋白GPⅡbⅢa复合物 

分 类 号：R542.22[医药卫生—心血管疾病]